Jean's health insurance policy has a 70/30 participation deductible. The policy has no other deductible provisions, nor does it have an annual out-of-pocket maximum limit. If Jean has brain transplant surgery that results in medical bills of $300,000, how much of the medical bills will her insurer pay?

Question

Quizplus · Accepted Answer

With a 70/30 participation deductible, the insurer will pay 70% of the medical bills after the deductible has been met, while the insured will pay the remaining 30%. Since no annual out-of-pocket maximum limit is stated, there is no cap on the amount of money the insured will pay. Therefore, Jean will be responsible for meeting the deductible of 30% of $300,000, or $90,000. The insurer will pay the remaining 70% of the medical bills, or $210,000.

Jean's Health Insurance Policy Has a 70/30 Participation Deductible